Tag Archives: Jack Snelling

Tackling the Health Bureaucracy

Government Bundles another GP agreement

There is a sense of “deja vu” today, as the Kangaroo Island doctors gear up for another tedious battle with the bureaucrats at Country Health SA.

You can read more in the media release below :

Media Release 4-3-13 KI Docs

The Island doctors have been told that the status quo (them providing 21 days out of 28 for the A&E on call roster … as well as complete 365 day cover for each of the anaesthetics & obstetrics rosters) is to come to an end on 1st April 2013.

The reason? Health bureaucrats demand that Island Doctors assume responsibility for the entire A&E roster, begging the question of ‘whose Hospital is it anyway‘? If they don’t, then the doctors will be removed from the A&E roster. Currently a locum does one week per month A&E on call, at a cost borne by the Health Department. To replace the local doctors will require a locum every day of the week – costing the Health Department even more. I’m no economist, but it seems an ‘interesting’ decision financially and one for which bureaucrats seem to be unaccountable.

Elsewhere in Australia, high fees paid to locums tend to drive out resident doctors, who also have to bear practice costs. There’s also a sense of deja vu – back in 2010 the Health Department replaced the Island doctors with locums – not only costing much, much more than the local doctors, but also leading to a significant drop in service (locums who could not plaster or insert an IV cannula were notable “fails”). One locum even fled after only a few hours, citing the ‘unbearable workload’.

So there you have it – local doctors no longer allowed to provide A&E services from 1st April 2013. The threat has been made by CHSA bureaucrats that anaesthetic and obstetric rosters will also be dissolved.

NOW is the time for the Kangaroo Island community to act if they want their doctors to remain able to treat them in A&E, deliver their babies or provide emergency & elective anaesthetics.

Hit the airwaves (891 Adelaide, fiveAA), write to the media (The Islander, The Advertiser), and tell the State Health Minister what you think.

Lack of accountability

Of course this is not the only problem the island doctors have had with Country Health SA. A colleague has described trying to deal with their bureaucracy as like ‘fighting candy floss’ – with meetings un-minuted, calls unanswered and a refusal to engage in meaningful or timely negotiations, it is very hard to get clear answers. There also appears to be a lack of institutional memory regarding previous decisions. We are not alone – the recently-departed Penola GP (who quit after being required to work a ludicrous 24:7 on call for over a year) has also hit out at the bungling Country Health SA bureaucracy.

Stand out gripes for recent times on KI include :

– failure to negotiate a new contract.

The previous expired in Nov 2011 and a ‘new’ contract was finally put to rural doctors in mid-2012. We are now in 2013…and rather than negotiate for a continuation of the status quo, CHSA have suggested the above

– failure to pay doctors under fee-for-service.

Of course I cannot discuss specific patient cases, but I can say that I am still chasing payment for in-patient services dating back to April last year. A common policy seems to be for the Hospital to call for a Doctor urgently to render assistance…then the urgency of that call to be disputed some months later by a pay clerk. Suffice it to say, call out fees differ if urgent vs non-urgent, the premium being to compensate urgency and impact on own clinic patients who have to wait. There is also a monthly battle over admitted vs non-admitted services – the former payable under fee-for-service, the latter charged as a private fee to the patient. Again CountryHealthSA seems to have a low threshold for calling the duty doctor – then arguing about payment later.

I am now owed thousands of dollars by CountryHealthSA over admitted patient fees. Sadly the agreed “dispute process” has lead to a series of unanswered emails and written demands for payment over months. Despite this I have kept on working at the Hospital, but it seems there is no accountability within the organisation to resolve this…

– the anaesthetic monitor fiasco.

Unbeknownst to any of the rural doctors (including the Country Health SA clinical lead for Anaesthetics), our existing monitors were replaced by new ones, reputedly costing $17,000 each. Estimates are that there has been over $500K spent across rural SA – despite the fact that these monitors were not needed (standards not mandatory) and replaced perfectly good existing equipment. This money spent even though we cannot get vital emergency equipment for our hospitals because “no money available’.

Jack Snelling is the Health Minister and perhaps should take note. The Health Dept needs to save $1 billion over five years. Perhaps some savings could be made within the bureaucracy?

So whilst all this hassle is going on, I am looking forward to a few weeks off and the chance to catch up with fellow #FOAMites at SMACC2013. Will be talking at 13:30 Tuesday 12/3/13 on ‘improving rural pre-hospital care in Australia’. Come along and heckle…

SMACC FINAL PROGRAM

BASICS model for Oz?

SA Health Budget Waste – Jack Snelling take note!

There has been a change in SA Health his year as outgoing Health Minister John Hill retires and Jack Snelling steps into place. I don’t envy whoever has this portfolio – the cost of health continues to rise, as does demand – and yet available health budgets are shrinking.

This week the ABC reported $1 billion health cuts over the next 4 years in SA health. The Minister was reported as saying “I think we can reduce the number of clinical staff and still maintain a reasonable level of services.” Personally I disagree – hospitals are already at capacity and despite ‘efficiency saving reports’ from the likes of KPMG, ministers need to realise that you cannot run health like a widget-factory; there needs to be surge capacity and slack in the system. However, I am all for saving money when appropriate. Which is why recent spending on unnecessary equipment by Country Health SA puzzles me.

In late 2012 a new anaesthetic monitor was delivered to us on Kangaroo Island. We were told it was part of an across Country Health SA strategy “to meet requirements” in Operating Theatres. Sure enough, the new monitor is a ‘you beaut’ device, with touchscreen technology and allowing us to do fancy things like spirometry and bispectral index sensing – which we never had before.

The problem is, the old monitor worked perfectly well and didn’t need replacing. I’ve checked and double-checked the ANZCA guidelines – and can’t find a requirement to have these extra functions which we’ve been told are ‘mandatory’. I’m not even convinced of the need for BIS, other than in paralysed patients being transported where risk of sedation failure may be present (read more on BIS here).

The disappointing thing is that we really need an EXTRA monitor in our location.

Currently post-op patients are monitored in ‘Recovery’ which is also our small ‘Emergency Room’. We use the MRX defib as a post-op patient monitor. Which is fine, so long as there is no emergency patient who also needs monitoring. As well as the need for two monitors, there have also been occasions when the anaesthetic monitor has malfunctioned – so having a backup immediately available makes good sense (particularly when you are on an Island!)

Using MRX defib as sole monitor in ED/Recovery - no backup!

Using MRX defib as sole monitor in ED/Recovery – no backup!

So my efforts in the past have been directed to getting an additional monitor for our ED/Recovery…as well as to purchase equipment to meet ANZCA standards (equipment to manage a difficult airway being one particular bugbear). We’ve had some success – we’ve sourced and fitted out a difficult airway trolley and some signage. Sadly there has been no committment by CHSA to supply a fibreoptic device or videolaryngoscope (I ended up purchasing my own) to manage a difficult airway…and have been told there are ‘no funds’ to purchase an additional monitor.

The Health Minister Mr Jack Snelling wants to save money. I get that. But this new monitor allegedly cost $17K. There are fifteen sites across CountryHealth SA which provide anaesthesia – so that’s $255K spent on monitors which may not be needed.

There you go Mr Snelling – a $255K saving for you.

I’ve emailed the CHSA lead for anaesthesia, Dr Sara Norton to ask about this. She tells me she was unaware of the decision to purchase these new monitors and did not consider either BIS or spirometry as mandatory requirements for monitoring. Which makes the purchase of these $17K per piece monitors even more puzzling. To date, Sara has not been able to get an explanation from Peter Chapman (Acting CEO of CHSA) re: this decision.

Seriously – that money could have been better spent in rural hospitals on essential additional equipment. We are repeatedly told there is ‘no money’ and purchase of much equipment falls upon efforts by local charities like CWA and Rotary. I think rural Australians deserve the same access to essential equipment as their metro cousins…and wish that decisions on equipment purchase were made in consultation with local clinicians.

Perhaps Jack Snelling should be asking Dr Peter Chapman – who is making these decisions and where is the governance?